Provider Demographics
NPI:1326649351
Name:CARR, OUIDA DEEDRA
Entity Type:Individual
Prefix:
First Name:OUIDA
Middle Name:DEEDRA
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OUIDA
Other - Middle Name:D
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2389 WESLEY CHAPEL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2819
Mailing Address - Country:US
Mailing Address - Phone:404-469-9867
Mailing Address - Fax:877-889-5105
Practice Address - Street 1:2389 WESLEY CHAPEL RD STE 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2819
Practice Address - Country:US
Practice Address - Phone:404-044-6998
Practice Address - Fax:877-889-5105
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG235925196OtherMEDICARE